Research Article: Feasibility of Provider-Initiated HIV Testing and Counselling of Tuberculosis Patients Under the TB Control Programme in Two Districts of South India

Date Published: November 19, 2009

Publisher: Public Library of Science

Author(s): Sophia Vijay, Soumya Swaminathan, Preetish Vaidyanathan, Aleyamma Thomas, L. S. Chauhan, Prahlad Kumar, Sonali Chiddarwar, Beena Thomas, Puneet K. Dewan, Nitika Pant Pai.

Abstract: Provider-initiated HIV testing and counselling (PITC) is internationally recommended for tuberculosis (TB) patients, but the feasibility, effectiveness, and impact of this policy on the TB programme in India are unknown. We evaluated PITC of TB patients across two districts in India considered to have generalized HIV epidemics, Tiruchirappalli (population 2.5 million) and Mysore (population 2.8 million).

Partial Text: The HIV/AIDS epidemic has increased the global tuberculosis (TB) burden, and has focused attention on the necessity to closely coordinate TB and HIV/AIDS control programme services [1]. Early detection of HIV infection among TB patients offers the opportunity to promptly link patients to HIV care interventions, such as cotrimoxazole prophylactic treatment (CPT) and antiretroviral treatment, which can reduce suffering and death [2].

This is the first study to provide tangible evidence from India of successful and timely implementation of PITC in TB patients through general health services in settings with high HIV prevalence. It also underscores the need for strengthening the uptake of ART services in such settings. In two districts, where HIV testing services were decentralized to a similar extent as TB services, half of TB patients with initially unknown HIV status were referred for HIV testing within 8 days of TB treatment initiation. This suggests that referrals for HIV testing were efficiently conducted, as would be necessary for patients to benefit from early HIV detection and treatment. After PITC policy implementation, HIV status was ascertained for 70% of TB patients, including 3108 TB patients (59%) who had previously unknown HIV status; 200 (3.8%) of TB patients were newly-detected as HIV infected. HIV status was ascertained most efficiently among adults aged 15–54 years, and with similar efficiency between males and females. Effective implementation of PITC for TB patients has been reported from other countries, including Thailand, South Africa and Kenya [12], [13], [14]. Earlier studies from India and Ethiopia warned of a possible gap between initial willingness for HIV screening and actual attendance at ICTC for testing [8], [15]. In this cohort, however, we observed that 92% of those referred for testing actually underwent HIV testing. We furthermore observed no effect of PITC implementation on TB case finding indicators, suggesting that apprehension of adverse effects on TB programme performance was unfounded.



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